Cancer Drugs Flashcards
MOA for Alkylating Agents
Act by changing structure of DNA in cancer cells
MOA for cyclophosphamide (Cytoxan)
attaches to DNA and disrupts replication
MOA for Antimetabolites
Act by disrupting critical pathways in cancer cells
MOA for methotrexate (Folex, Mexate, others)
blocks synthesis of folic acid (vitamin B9) to inhibit replication
MOA for Antitumor Antibiotics
Act by inhibiting cell growth through cytotoxicity
MOA for doxorubicin (Adriamycin)
attaches to DNA.
Distorts double helical structure and prevents normal DNA and RNA synthesis
MOA for Hormones/Hormone Antagonists
slow growth of reproductive-related tumors
MOA for tamoxifen (Nolvadex)
blocks estrogen receptors on breast cancer cells)
MOA for Natural Products
Kill cancer cells by preventing cell division
MOA for vincristine (Oncovin)
cell-cycle-specific (M-phase) agent that kills cancer cells by preventing their ability to complete mitosis
MOA for Biologic Response Modifiers
Stimulate or assist client’s immune system to rid itself of cancer cells
MOA for interferons,
Slow spread of viral infections and enhance activity of lukocytes
MOA for interleukins,
Stimulate platelet production in immunosuppressed clients
Enhance capabilities of immune system
Stimulate cytotoxic T cells
Increase B-cell and plasma-cell production
Promote inflammation
MOA for sirolimus (Rapamune) and azathioprine (Imuran)
Inhibit aspects of lymphocte replication
MOA for Antimetabolites
Immunosuppressant
Inhibit aspects of lymphocte replication
MOA for Calineurin Inhibitor
Immunosuppressant
Bind to calcineurin and disrupt T cells, to inhibit helper T cells
MOA for Cyclosporine (Sandimune, Neoral) and tacrolimus (Prograf)
Bind to calcineurin and disrupt T cells, to inhibit helper T cells
MOA for Glucocorticoid Steroids
Immunosuppressant
Inhibit inflammation
Glucocorticoid Steroids
(Immunosuppressant) are use for
Used for short-term therapy for severe inflammation
Side effects of cyclophosphamide (Cytoxan)…..
can cause significant bone-marrow suppression
immunosuppressant effects, thrombocytopenia
Nausea, vomiting, anorexia, diarrhea
Alopecia (hair loss), hemorrhagic cystitis
Side effects of methotrexate (Folex, Mexate, others) …. Antimetabolites
fatal bone-marrow toxicity at high doses
• Hemorrhage and bruising, low platelet counts
• Nausea, vomiting, anorexia
• Gastrointestinal ulceration, intestinal bleeding
Side effects of doxorubicin (Adriamycin)
cardiotoxicity, dysrhythmias
Irreversible heart failure, lower blood-cell counts
Nausea, vomiting
Side effects of tamoxifen (Nolvadex)
nausea and vomiting
• Association with increased risk of endometrial cancer and thromboembolic disease
• Hot flashes, fluid retention, vaginal discharges common
Development of cross-gender secondary sexual characteristics
• Common, yet distressing, side effects of sex-hormone therapy
Side effects of vincristine (Oncovin)
nervous system toxicity, numbness and tingling in limbs
• Muscular weakness, loss of neural reflexes, pain
• Paralytic ileus, constipation, alopecia
Side effects of interferons,
flulike syndrome in 50% of clients (diminishes as therapy progresses)
Headache, nausea, vomiting, diarrhea
Anorexia, depression, suicidal ideation.
With prolonged therapy, immunosuppression, hepatotoxicity, neurotoxicity
Examples of Immunosuppressants
Glucocorticoids
Antimetabolites
Antibodies
Cacineurin inhibitors
Antibodies
Basiliximab (Simulect) and daclizumab (Zenapax)
- Prevent acute rejection of kidney transplants
Infliximab (Remicade)
- Suppresses inflammation in autoimmune disorders
Muromonab –CD3 (Orthoclone OKT3)
- Prevent rejection of kidney, heart, and liver transplants
- Depletes bone marrow of T cells prior to marrow transplant
Side effects of Calineurin Inhibitor
Immunosuppressant
75% of clients experience reduction in urine flow
over 50% will experience hypertension
Infections, headache, gingival hyperplasia, elevated hepatic enzymes , hypertension, and elevated hepatic enzymes
cyclophosphamide (Cytoxan) is an example of a __________.
Alkylating Agent
methotrexate (Folex, Mexate, others) is an example of ________.
Antimetabolites
doxorubicin (Adriamycin) is an ______.
Antitumor Antibiotics
tamoxifen (Nolvadex) is an ______.
Hormones/Hormone Antagonists
vincristine (Oncovin) is an _______.
Natural Products
Interferons, interleukins, monoclonal antibodies are examples of __________.
Biologic Response Modifiers
sirolimus (Rapamune) and azathioprine (Imuran) are examples of ________.
Antimetabolites
Immunosuppressant
Cyclosporine (Sandimune, Neoral) and tacrolimus (Prograf) are examples of ______.
Calineurin Inhibitor
Immunosuppressant
Basiliximab (Simulect) and daclizumab (Zenapax) does what?
- Prevent acute rejection of kidney transplants
Infliximab (Remicade) does what?
- Suppresses inflammation in autoimmune disorders
Muromonab –CD3 (Orthoclone OKT3) does what?
- Prevent rejection of kidney, heart, and liver transplants
- Depletes bone marrow of T cells prior to marrow transplant
You’ll know it’s an antibody because it’ll have the suffix….
-ab….
Basiliximab
Infliximab
Muromonab
Hormones other than tamoxifen (Nolvadex) may be …..
palliative rather than curative
Important that both client and family understand this limitation
Antimetabolites
fatal bone-marrow toxicity at high doses
Nursing Implications: Alkylating Agents
- Discontinue if RBC, WBC, and platelet counts fall
- Use caution with hepatic or renal impairment, recent steroid therapy, leukopenia, or thrombocytopenia
- Hydrate clients with IV or oral fluids before starting chemotherapy
- Advise clients to avoid crowds and those with respiratory infections
- Be alert to possible development of blood dyscrasias
- Monitor nutritional intake
- Assess for nausea and vomiting
- Be prepared to administer antiemetic drugs
- Offer ice chips or ice pops to relieve mouth pain
- Assess skin integrity
- Monitor for signs of hearing loss
- Inform clients of potential adverse impact on fertility
- Alkylating agents range from pregnancy category C to X
- Maintain strict medical asepsis
Nursing Implications: Antimetabolites
- Contraindicated in pregnancy, hepatic, cardiac, and renal insufficiency; myelosuppression; and blood dyscrasias
- Avoid pregnancy for at least six months after therapy with category X drug
- Adverse effects common to other antineoplastics may occur
- Monitor for photosensitivity and idiosyncratic pneumonitis
- Teach clients to use good oral hygiene and encourage mouth rinses
- Monitor IV site frequently for extravasation
Nursing Implications: Antitumor Antibiotics
- Assess cardiac status—obtain baseline ECG
- Assess for pregnancy and lactation
- Produce same cytotoxic effects as other antineoplastics
- Risk of hypersensitivity reactions exists as with other antibiotics
- Changes in rectal mucosa contraindicate suppositories or rectal temperatures
- Wear protective clothing (gloves, mask, and apron) when preparing drug
- Monitor IV site because doxorubicin is a severe vesicant
- Give drug through large-bore, quickly running IV; monitor for extravasation
Nursing Implications: Hormones and Hormone Antagonists
• Assess for pregnancy and breast-feeding
• Hormones other than tamoxifen (Nolvadex) may be palliative rather than curative
o Important that both client and family understand this limitation
• Development of cross-gender secondary sexual characteristics
o Common, yet distressing, side effects of sex-hormone therapy
• Fertility sometimes affected
• Discuss these effects frankly with client, and offer support
Nursing Implications: Natural Products
• Assess allergy to plants or flowers, including herbs or foods
• Vincristine (Oncovin) may produce acute bronchospasm and skin rashes
• Inquire if female clients are pregnant or breast-feeding
• Many of same cytotoxic effects as other antineoplastics
• Emphasize need to establish nutritional plan to combat constipation
o High fluid and fiber intake
• Monitor blood pressure
• Observe clients for symptoms such as headache, dizziness, or syncope
• May produce severe mental depression; assess possibility of suicidal ideation
Adverse effects of therapy (general for all of them… serious)
• Alopecia
• Mucositis (severe nausea, vomiting, diarrhea)
Drugs with high emetic potential pretreated with antiemetics (Compazine, Reglan, Ativan)
Vesicants
Can cause tissue injury (extravasation)
Know emergency treatment before giving vesicants IV
Long-term consequences
Possible infertility
Increased risk for secondary tumors
Nursing Implications: Immunosuppressents
Contraindicated in client with leukemia, metastatic cancer, active infection, renal or liver disease or those who are pregnant
Obtain vital signs and results of lab testing to provide baseline data
Monitor for indications of infection
Monitor degree of bone-marrow suppression (thrombocytopenia and leukopenia)
Monitor clients taking azathioprine (Imuran) for development of secondary malignancies
Nursing Implications for Immunization Agents
Assess for risk-based precautions: pregnancy, diabetes, heart disease, renal failure
Provide education on importance of receiving vaccinations
Answer questions and concerns regarding risks and benefits of vaccines
Instruct on recommended immunization schedule and follow-up vaccines
A Vaccine provides
ACTIVE immunity.
